The metabolic syndrome (MetS) is a cluster of cardiovascular indices that appear to be linked by poorly- understood insidious processes that increases risk for coronary heart disease (CHD), stroke, Type 2 diabetes (T2DM) and chronic kidney disease (CKD)-diseases that are highly prevalent among African Americans. The individual components of MetS include abdominal obesity, high triglycerides, low HDL cholesterol, high blood pressure (BP), and high fasting glucose. A classification of MetS in a given individual has traditionally been based on a combination of cut-off points for these different components. However, the use of cut-offs is liable to miss classifying individuals with moderate elevations that are just below the cut-off level. Additionally, MetS criteria have been shown to exhibit racial/ethnic differences in their association with disease. We have designed a sex- and race/ethnicity-specific continuous MetS severity score that takes into account how the individual components of MetS (elevated BP, low HDL, etc.) cluster and correlate differentially by sex and racial/ethnic group. Thus, based on these differences the score assigns different weights to each component by sex and race/ethnicity. A given individual's score can be calculated from standard clinical measures using an equation specific to his/her sex and racial/ethnic group. This novel score has excellent potential for clinical application for risk assessment. Not only is the score able to take into account unique features of MetS seen in African Americans but the score expresses MetS severity in a way that can be compared between individuals and followed over time within an individual. We propose to use this MetS severity score to evaluate participants in the Jackson Heart Study to gain information critical to using this tool in clinical application. Our plan is three-fold. 1) We will assess baseline and longitudinal epidemiologic and lifestyle factors that are likely to affect MetS severity, 2) we wil assess baseline MetS severity between individuals who do and do not progress to develop CHD, stroke, T2DM and CKD, and 3) we will evaluate intra-individual changes in MetS severity leading up to diagnosis of the above CVD- associated diseases. We have gathered a team with multiple areas of expertise and will use our findings to provide guidance to clinicians regarding the use of MetS severity as an ominous indicator of future disease- with an ultimate goal of CVD prevention among African American patients.